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Montana rates for HCPCS A5513

For Diabetics Only Multiple Density Insert Custom Molded From Model Of Patients Foot Total Contact With Patients Foot Including Arch Base Layer Minimum Of 3/16 Inch Material Of Shore A 35 Durometer Or Higher Includes Arch Filler And Other Shaping Material Custom Fabricated Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.80 / $16.80 / $100.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.81 / $52.81 / $52.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.21 / $56.78 / $56.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.21 / $56.78 / $56.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.14 / $54.08 / $56.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.29 / $42.62 / $56.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.95 / $24.28 / $41.58